Preventive actions of allergen immunotherapy: the facts and the effects in search of evidence.
Preventive actions of allergen immunotherapy: the facts and the effects in search of evidence.
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DOI：
10.1186/s12948-017-0070-7
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发表时间：
2017-01-01
期刊：
影响因子：
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通讯作者：
Ridolo, Erminia
中科院分区：
文献类型：
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作者：
Martignago, Irene;Incorvaia, Cristoforo;Ridolo, Erminia
过敏原免疫疗法（AIT）是唯一有效的治疗过敏的原因。目前，针对过敏性鼻炎和哮喘，可采用皮下免疫治疗（SCIT）和舌下免疫治疗（SLIT），而对于膜翅目蛇毒过敏，仅推荐皮下免疫治疗。大量的试验和荟萃分析表明，AIT在减少过敏临床症状和使用抢救药物方面的有效性和安全性，但其预防能力尚待研究。其中最重要的作用是通过毒液免疫疗法（VIT）预防对膜翅目昆虫蜇伤的潜在致命的过敏反应。目前已有一定数量的研究表明，两种形式的AIT都能够防止变应性鼻炎发展为哮喘和新的致敏性的发展。这些影响应该与AIT的作用机制有关。事实上，已经证明SCIT和SLIT都能够改变树突状细胞对过敏原的呈现，从而改变过敏原特异性T细胞的表型，从典型的过敏性炎症th2型反应转变为th1型反应。此外，过敏原特异性T调节细胞（Treg）通过产生抑制细胞因子（如IL-10和tgf - β）发挥关键作用。然而，预防效果的唯一明确证据与VIT有关，而其他结果需要进一步调查。
Allergen immunotherapy (AIT) is the only treatment that works on the causes of allergy. Available AIT nowadays are subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) for allergic rhinitis and asthma, while for allergy to Hymenoptera venom only subcutaneous route is recommended. A bulk of trials and meta-analyses demonstrated that efficacy and safety of AIT in decreasing allergic clinical symptoms and use of rescue medications, while its preventive capacity is yet under investigation. The most important of these effects is the prevention of potentially fatal anaphylactic reactions to Hymenoptera stings by venom immunotherapy (VIT). A certain number of studies thus far available showed that AIT, in both forms, is able to prevent the progress of allergic rhinitis into asthma and the development of new sensitizations. These effects should be related to the mechanisms of action of AIT. In fact, it has been demonstrated that both SCIT and SLIT are able to modify the allergen presentation by dendritic cells, with result in modification of the phenotype of allergen-specific T cells, switching from the typical of allergic inflammation Th2-type response to a Th1-type one. Also allergen-specific T regulatory (Treg) cells play a pivotal role by producing suppressive cytokines, such as IL-10 and TGF-beta. However, the only plain evidence of a preventive effect concerns VIT, while the other outcomes need to be furtherly investigated.